For Hadas - immune testing

For Hadas - immune testing

minka
minka

May 16th, 2012, 10:54 pm #1

Hi Hadas,

I saw your questions below about the immune testing and consult with Dr. B.raverman (Reproductive Immunologist). I found out today that he submitted my labs order to R.eprosource as immunology and not fertility-related. The girl at R.eprosource said this should help get the labs covered by insurance.

I have not had my phone consult with him yet, but I have read on the Yahoo immune board that the code used is phone consult and also not fertility related.

Also, just wanted to note that he does work remotely and you do not have to visit his office at all for consultation or monitoring. He even works with women in other countries. The introductory e-mail they sent me explains all the costs involved with the consult and monitoring. Each person's insurance coverage is different, so it will depend on your insurance as far as what will be covered. I can share this info with you offline if you like

I have heard great things about B.raverman and I am thrilled to have my immune testing/treatment done with him. I have some known immune issues (autoimmune skin disorder, mild endometriosis, elevated antithyroid antibodies, and a basic lab test showed elevated Natural Killer Cells). Do you have or suspect any autoimmune issues? I would say failure to get a BFP alone is enough to suspect something is going on. (We have been TTC nearly 5 years and have never seen a BFP.)

Finally, here is his web site in case you don't have it: http://www.preventmiscarriage.com/

Let me know if you have any other questions and I will share with you what I know so far. I think it's good of you to pursue immune issues... I have a strong feeling many unexplained infertility issues are autoimmune in nature and many women find out about it "too late."

minka
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Hadas
Hadas

May 17th, 2012, 3:37 am #2

Hi Minka,
Thank you so much for your post! I did fill out a questionnaire on Dr. B's site yesterday and actually got a call from him personally today! He left a voicemail himself, so I'll call them back tomorrow to see how the consult works. He said it can be done by phone or Skype, so that's great. The only problem is that they're only out of network with my insurance (BCBS), so I have to see what the cost will be.

A friend of mine worked with the De Beer center in CA (she's pg now after 7 years). Do you know anything about them? I may look into them if they accept my insurance.

Thanks again for your help and good luck!!

Hadas
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Sara Q
Sara Q

May 17th, 2012, 5:41 am #3

Hi Hadas,

I don't know anything about Dr. Braverman, but I am currently a patient at the Alan Beer's Center in CA. I have failed 4 IVFs, 3 of which they transferred 1-3 "good quality" embryos - and never, every a BFP. Ever.

Three months ago I found out I had endometriosis and a small septum in my uterus. Woulda been good to know earlier, huh? They did a lap to remove the endo - which was mostly on my bowel. (I wouldn't let them go inside my ovaries because I was so worried about exaccerbating my DOR - I even had them change the consent form. I've been around the block more than once in this IVF game...)

So just to not leave any stone unturned I went to the Beer's Center. Thankfully, I didn't end up having a lot of problems, but it does appear I have one big problem - my HLA blocking antibodies, which basically tell your body to not attack an embryo are WAY too low. They are supposed to be above 50 and mine are 1.8. So their recommendation was to have a LIT - which unfortunately is not available in the U.S. anymore. So it's off to Mexico we go.....which Dr. Check supports. (It's the only immunological treatment he really believes in, which is easier for me since our next step is to do a low stim IVF with him.

I don't know how our story will turn out, but I will certainly let you know. Good luck with whatever you choose to do.

Hugs,

Sara Q

P.S. Our insurance paid for almost all of the treatment and consults from the Beer's Center. And we have really, really crappy insurance.
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Hadas
Hadas

May 17th, 2012, 2:11 pm #4

Hi,
Thank you for this information!
I'm on the De Beer website now and I guess I have to call them about insurance, etc. It says that there's a charge for reviewing a file and a consultation fee.

In your experience, are both of these covered by insurance? We ran out of fertility coverage so I want to make sure I find a place that can cover this in a different way.

Best of luck to you!! What is LIT, by the way?

Hadas
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minka
minka

May 17th, 2012, 2:49 pm #5

I also have BCBS and the "middleman" lab that B.raverman uses (R.eprosoource) is a preferred participant under BCBS. I have read on the Yahoo immune board that other women have had luck getting all their labs paid for by BCBS. So I'm hoping for the same with me

As for monitoring fees, I am not sure. I will still have them submit everything to my insurance (their intro e-mail actually said they do work with BCBS...) and hope for the best.

Aside from B.raverman and the B.eer Center, there is another Reproductive Immunologist in Chicago, her name is Dr. K.wak Kim and she studied under Alan B.eer for many years, and started her own RI practice at the R.osalind Franklin Medical Center. I have heard good things about her also. The only caveat is that she requires the first visit to be in-person so there is the additional travel expense. She apparently has an amazing 3D Doppler ultrasound machine that shows in extreme detail what is going on with your bloodflow to the uterus. The other thing is Dr. K.wak is a firm believer in IVIG infusions which are SUPER expensive... in the thousands for each treatment x how ever many times you need to do it.

The B.eer Center does believe in LIT (Lymphocyte Immune Therapy) which is currently only done in Mexico. Patients travel to Nogales to get this done. I did hear that a clinic in Markham, Ontario (near Toronto) will also be offering this treatment soon but I don't know the details. Here is some info on LIT from the B.eer site:

http://repro-med.net/repro-med-site2/in ... &Itemid=25

Instead of LIT or IVIG, B.raverman typically treats with Neupogen injections and/or Intralipids infusions, which are much cheaper than IVIG and LIT (considering the travel cost...). I do not have first hand experience with any of these but cost is a major factor for us and based on the success stories I have seen with B.raverman I feel very good in choosing him.

As Nancy mentioned, the B.eer book "Is your body baby-friendly" is the best start to get yourself acquainted with the concept of Reproductive Immonology. It is kind of overwhelming with all of the immune issues that come into play, but it is kind of the "bible" when it comes to learning this stuff.

minka
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Nancy
Nancy

May 17th, 2012, 3:10 pm #6

Hi Minka,
Thank you so much for your post! I did fill out a questionnaire on Dr. B's site yesterday and actually got a call from him personally today! He left a voicemail himself, so I'll call them back tomorrow to see how the consult works. He said it can be done by phone or Skype, so that's great. The only problem is that they're only out of network with my insurance (BCBS), so I have to see what the cost will be.

A friend of mine worked with the De Beer center in CA (she's pg now after 7 years). Do you know anything about them? I may look into them if they accept my insurance.

Thanks again for your help and good luck!!

Hadas
Hi! When I set up my consult w/ B raverman, they said it was $350. If you have out of network coverage through BCBS, you can submit the claim yourself and get reimbursed. If you don't have out of network coverage, then I guess you "eat" the $350 consult fee. I would imagine after the tests come back, you would have another consult and not sure what that fee would be.

As Minka said, the labs are taken care of by Reprosource (I erronesouly called them Reprotek in my other post) and I am pretty sure they are in-network for BCBS (but I guess it depends which plan you have). I used Reprosource last year for AMH testing through BCBS Anthem and I had a $75 fee, but they paid the rest...

It sounds like it doesn't go towards IF coverage anyway w/ B raverman...not sure about Beer Center or Dr. K.wak.

GL!

Nancy
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Sara Q
Sara Q

May 17th, 2012, 3:17 pm #7

Hi,
Thank you for this information!
I'm on the De Beer website now and I guess I have to call them about insurance, etc. It says that there's a charge for reviewing a file and a consultation fee.

In your experience, are both of these covered by insurance? We ran out of fertility coverage so I want to make sure I find a place that can cover this in a different way.

Best of luck to you!! What is LIT, by the way?

Hadas
Hi Hadas,

Good questions. We submitted the consultation fee to our insurance, and they covered about 70% of the $600. (We are all maxed out of fertility coverage as well, but it was coded as immunology, so that's why it was partially covered as a "out of network." We haven't submitted the $80 yet, but mostly because I forgot to do it - thank you for the reminder! Also, all the tests were covered, and even the ones that we though weren't covered originally (2 out of like 25) were partially covered (at 70 to 60%) when we submitted the receipts. But I think it does depend on what kind of insurance plan you have; we have a PPO with Cign.a)

Also, LIT, like Minka said in her message, stands for Lymphocyte Immunization Therapy - it's a procedure where they inject the husbands white blood cells into the wife's skin to prepare her body for pregnancy. Check out this site for more info.

http://www.repro-med.net/repro-med-site ... &Itemid=12

And Minka, what they told me at the B.eer's Center is that LIT is done in Canada NOW, it's just that only Canadian citizens are able to do it - or maybe it was that U.S. citizens were specifically not able to get the treatment done in Candada - either way it has to do with politics of medicine and the two countries. Crazy!

Take care ladies,
SQ
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Hadas
Hadas

May 17th, 2012, 3:33 pm #8

I also have BCBS and the "middleman" lab that B.raverman uses (R.eprosoource) is a preferred participant under BCBS. I have read on the Yahoo immune board that other women have had luck getting all their labs paid for by BCBS. So I'm hoping for the same with me

As for monitoring fees, I am not sure. I will still have them submit everything to my insurance (their intro e-mail actually said they do work with BCBS...) and hope for the best.

Aside from B.raverman and the B.eer Center, there is another Reproductive Immunologist in Chicago, her name is Dr. K.wak Kim and she studied under Alan B.eer for many years, and started her own RI practice at the R.osalind Franklin Medical Center. I have heard good things about her also. The only caveat is that she requires the first visit to be in-person so there is the additional travel expense. She apparently has an amazing 3D Doppler ultrasound machine that shows in extreme detail what is going on with your bloodflow to the uterus. The other thing is Dr. K.wak is a firm believer in IVIG infusions which are SUPER expensive... in the thousands for each treatment x how ever many times you need to do it.

The B.eer Center does believe in LIT (Lymphocyte Immune Therapy) which is currently only done in Mexico. Patients travel to Nogales to get this done. I did hear that a clinic in Markham, Ontario (near Toronto) will also be offering this treatment soon but I don't know the details. Here is some info on LIT from the B.eer site:

http://repro-med.net/repro-med-site2/in ... &Itemid=25

Instead of LIT or IVIG, B.raverman typically treats with Neupogen injections and/or Intralipids infusions, which are much cheaper than IVIG and LIT (considering the travel cost...). I do not have first hand experience with any of these but cost is a major factor for us and based on the success stories I have seen with B.raverman I feel very good in choosing him.

As Nancy mentioned, the B.eer book "Is your body baby-friendly" is the best start to get yourself acquainted with the concept of Reproductive Immonology. It is kind of overwhelming with all of the immune issues that come into play, but it is kind of the "bible" when it comes to learning this stuff.

minka
Hi Minka,
Thank you again for sharing all of this information!

I have to say this is already overwhelming, but I'm intrigued! At this stage, though, I'm just curious about 2 things: 1. Do I have any immune issues? 2. What treatment is available?

If it's too out there in terms of treatment, I may not pursue it, but I'm very curious.

Thank you so much fo all of this!
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Hadas
Hadas

May 17th, 2012, 4:48 pm #9

Hi Hadas,

Good questions. We submitted the consultation fee to our insurance, and they covered about 70% of the $600. (We are all maxed out of fertility coverage as well, but it was coded as immunology, so that's why it was partially covered as a "out of network." We haven't submitted the $80 yet, but mostly because I forgot to do it - thank you for the reminder! Also, all the tests were covered, and even the ones that we though weren't covered originally (2 out of like 25) were partially covered (at 70 to 60%) when we submitted the receipts. But I think it does depend on what kind of insurance plan you have; we have a PPO with Cign.a)

Also, LIT, like Minka said in her message, stands for Lymphocyte Immunization Therapy - it's a procedure where they inject the husbands white blood cells into the wife's skin to prepare her body for pregnancy. Check out this site for more info.

http://www.repro-med.net/repro-med-site ... &Itemid=12

And Minka, what they told me at the B.eer's Center is that LIT is done in Canada NOW, it's just that only Canadian citizens are able to do it - or maybe it was that U.S. citizens were specifically not able to get the treatment done in Candada - either way it has to do with politics of medicine and the two countries. Crazy!

Take care ladies,
SQ
Thanks again for this very helpful information!
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Hadas
Hadas

May 17th, 2012, 4:48 pm #10

Hi! When I set up my consult w/ B raverman, they said it was $350. If you have out of network coverage through BCBS, you can submit the claim yourself and get reimbursed. If you don't have out of network coverage, then I guess you "eat" the $350 consult fee. I would imagine after the tests come back, you would have another consult and not sure what that fee would be.

As Minka said, the labs are taken care of by Reprosource (I erronesouly called them Reprotek in my other post) and I am pretty sure they are in-network for BCBS (but I guess it depends which plan you have). I used Reprosource last year for AMH testing through BCBS Anthem and I had a $75 fee, but they paid the rest...

It sounds like it doesn't go towards IF coverage anyway w/ B raverman...not sure about Beer Center or Dr. K.wak.

GL!

Nancy
I'm planning on calling today to see how pricing and insurance work.

Thanks!
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